Despite the variety of changes occurring in the lymphatic apparatus of the lungs with cancer, the relationship between the location of the tumor in a particular lobe and the defeat of the metastases of various groups of lymph nodes is clearly established.
In cancer of the upper lobe of the right lung, the first lymphogenous metastases affect the nodes of the intrapulmonary region of the regional collector, which are located at the base of the upper lobar bronchus, as well as the upper interlobar. Spreading further higher and reaching the root lymph nodes, metastases are usually localized in their upper and anterior groups. In the mediastinum, the metastases of the upper lobe cancer naturally affect the right tracheobronchial lymph nodes. Further, with an upward lymphatic current, they spread to the nodes of the right paratracheal group in stages: from the lowest of them to those located at the upper aperture of the chest near the brachio-cephalic arterial trunk. Often adjacent lymph nodes of the prevenous and prepericardial groups are also involved in the tumor process. Having reached within the mediastinum of the upper lymph nodes that make up the right vertical lymphatic collector, metastases can go higher to the nodes of the right deep lymphatic collector of the neck, which is the final stage of lymphogenous metastasis of cancer of the upper lobe of the right lung.
Subsequent growth and development of metastases in the regional lymph nodes over time causes a disturbance in the normal lymph flow and lymph progression along collateral or newly forming vessels. In this case, individual metastases can reach the lymph nodes of the pretracheal and retrotracheal groups. Cancer metastasis of the upper lobe of the right lung to the groups of bifurcation and peresophageal lymph nodes is rare and, as a rule, is inherent in the advanced stages of the development of the disease, when a pronounced block of lymph outflow in the ascending direction prevents its normal progression. As it was rightly noted , tumors of the upper lobes of the lungs do not spread through the lymphatic vessels in the direction of the diaphragm, without first spreading upwards.
Cancers of the middle lobe metastasize through the lymphatic collectors in a very peculiar way, which is largely determined by the features of the outflow of lymph from this area. This process is characterized by the early timing and extensive Nost .
The first lymphogenous metastases usually affect the intrapulmonary nodes, grouping at the base of the middle lobe bronchus. Then they spread along the intrapulmonary sections of the lymphatic collector, reaching the interlobar lymph nodes located along the pulmonary artery and near the intermediate bronchus. Often is the metastasis of lung cancer of mid-lobe localization by direct lymphatic connections, bypassing these groups of nodes, into the lymph nodes of the root area. Here, tumor metastases most often affect the anterior group of nodes, somewhat less commonly, the upper and lower. Further, within the mediastinum, the right tracheobronchial and bifurcation lymph nodes, as well as the nodes of the prepericardial and pretracheal groups, are involved quite early in the tumor process. Subsequently, metastasis occurs in an ascending direction along the chains of right paratracheal and prevenous lymph nodes, reaching their upper sections. Metastasis ends within the regional lymphatic collectors of the middle lobe of the right lung in the lymph nodes of the neck — lower deep jugular. Blockade of lymph outflow through regional collectors can cause metastasis of lung cancer of this localization within the mediastinum to the peresophageal lymph nodes.